Broomfield Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that children, young people their families and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of children, young people their families and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that children, young people their families could access care in ways that met their personal circumstances and protected equality characteristics. This is the first assessment for this service. This key question has been rated Requires Improvement.

This meant people’s needs were not always met through good organisation and delivery. Young people and their families were not always involved in decisions about their care. The service did not always provide information children and young people could understand. Families did not always know how to give feedback and were not always confident the service took it seriously and acted on it. The service was accessible but there could be delays in receiving outpatient appointments. Child and young people did not always receive fair and equal care and treatment due to the high demand on the service and short staffing levels. The service did not always work towards to reducing health and care inequalities and did not use available resources to improve this.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure children, and young people were at the centre of their care and treatment choices.

The service did not always make sure children, and young people were at the centre of their care and treatment choices. Teenagers using the service had little provision available that was age appropriate and there were limited resources for those receiving treatment for mental health and eating disorders.

Leaders told us they had seen a steady increase in the number of children in mental health crisis and told us their service was not always equipped to deal with complex cases. They told us there could be long waits for an appropriate external referral bed to be available. Which would leave young people, and their families frustrated.
Nursing leaders told us they worked with community partners during referral processes but due to a national shortage of appropriate external bed spaces this caused additional pressure to in-patient wards.

Clinical and non-clinical staff also voiced concerns over the lack of training and available provisions to support teenagers within department. Leaders understood the need for suitable facilities that were safe and training to support better person-centred care. However, due to financial restraints on the service there was limited solutions available.

We scored the service as 1. The evidence showed significant shortfalls. There were significant shortfalls in how the service understood the diverse health and care needs of children, young people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.

Care provision on the in-patient ward and paediatric assessment unit fluctuated depending on how busy the service was. Staff in these areas told us care standards were not always consistent. There was not always continuity of care when children moved between department. For example, it was not always clear from medical notes when and why children were moved from children’s emergency department up to the ward.

The service had long delays on its treatment waiting lists. Broomfield hospital had over 1900 children waiting for non-admission appointments. The service was not meeting the national outpatient appointment target of 18 weeks. Staff expressed concern at further impact on waiting times due to changes to booking system and losing ability to be responsive to children and young people’s needs. Based on national benchmarks, performance of outpatient clinics, including waiting times, Mid and South Essex NHS Foundation Trust (MSEFT) was a significant outlier for with poor productivity, value for money and patient experience

We requested evidence of how the service monitored availability of children and young people’s medical note across services. Systems used to shared information with General Practitioners (GP) and other healthcare providers was inconsistent and the service did not have any monitoring measures in place to identify any gaps in access. Broomfield did not have electronic care record systems and were paper based. It was not clear how children and young people’s care information was shared with GPs in a timely way.

We scored the service as 1. The evidence showed significant shortfalls. The service did not supply information for children, young people and their families.

Information provided to people was inconsistent across children and young people’s wards and departments. Some parents and carers had been signposted to QR codes (which link them to information using their phone) and notice boards. Others told us they had not been given any information at all.

The service did not always signpost people to appropriate, accurate and up-to-date information in formats tailored to individual’s need. For example, information provided was not available in different languages and did not cater to the diverse population it served. We requested information to evidence if staff had access to interpretation and translation services and how they were used within children and young people services. The service did not collect any monitoring data around this service, and it was unclear if there had been any gaps in provision due to recent contract changes.

The service had an accessible information policy but did not specifically relate to children and young people and their potential diverse communication needs. Therefore, staff did not have clear up to date guidance on how to make information accessible for children, young people and families to meet their needs.

We also asked for evidence how leaders were assured staff and processes were complying with the Accessible Information Standard. The NHS England (NHSE) Accessible Information Standard describes how NHS and adult social care services should identify, record, flag, share, meet and review people’s information and communication needs. This was not provided.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make it easy for children, young people and their families to share feedback and ideas, or raise complaints about their care, treatment and support.

Young people and their families using the service told us staff did their best to listen and support individual needs. It was not always easy for young people and their families to share feedback and ideas for improvements. However, parents in the paediatric outpatients told us they had informed discussions with staff and supported to give feedback.

The neonatal unit gathered feedback from parents through surveys, but it was not always clear what actions had been taken in response to the survey results. Department surveys were not always utilised in other areas of the children and young people's service. However, these areas did gather feedback by using the national NHS Friends and Family Test survey.

The service did not always monitor how they responded to feedback or complaints. They had received 19 formal complaints in the last 12 month. Of those from paediatric outpatients, 60% were complaints about poor care from a doctor or consultant and on inpatient wards around 75% delays or change in patient pathways. Complaints were not always dealt with in line with trust policy. For example, information provided by the Trust showed only 33% of complaints in the last 12 months had been responded to in line with Trust policy. Therefore, we were not assured that complaints and concerns were seen as an opportunity to drive improvement in a proactive and timely way.

We asked for evidence how the service formally listened to children, young people’s and their family’s voices. We were provided with the terms of references for the Trusts Autism working group set up in June 2024. These were monthly meetings attended by staff and parents. However, we were not provided with any reports or meeting minutes. The associated action log showed limited progress had been made since the group launch.

Senior trust leaders acknowledged they needed more engagement with children and young people using their services and would aspire to implement this in the future.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

Most young people and their families told us they had been offered equal access to care and services. For children and young people with additional medical / learning needs. families were offered a ‘yellow card’ for direct access into the paediatric assessment unit (PAU). This meant they could bypass accident and emergency to be seen by paediatric teams.

However, staff were concerned yellow card holders might experience long delays for triage in PAU and some might become more unwell in the waiting room before being assessed. Staff told us information regarding yellow card holders is sometimes difficult to access, for example if a ward clerk was not on duty information sharing might be delayed.

We requested data on referral to treatment times (RTT) and any information on children and young people triage data. This information was collected trust wide. It showed 41% of the 7,785 children and young people waiting for treatment, 41% received this within 18 weeks of referral. The remaining 59% were over 18-week national target. The trust was consistently performing below the trusts national average. We also requested for evidence how they monitored any harm because of delays in RRT times. We were provided with a RTT harm review procedure but was not provided with any data or information show this process had been completed and what actions had been identified.

Data provided at time of assessment showed that in the last 12 months out of the 4,473 children and young people admitted to inpatient wards, 1.1% of those were admitted to predominantly adult areas. We also requested any standard operating procedure for the admission of children and young people to adult wards. This was not provided. There was a lack of clear guidance for staff and oversight of admissions processes for children and young people in adult areas.

The service had ongoing concerns around how to manage children and young people who Did Not Attend (DNA) appointments. From November 2023 to October 2024, Broomfield had 1504 children who failed to attend their first appointment. This represented 6.0 % of all new appointments. Leaders told us they had been working with an external text message service to review and improve attendance rates. We were not provided with details of how any actions taken had positively influenced DNA rates and its impact on equity in access for all.

We scored the service as 1. The evidence showed significant shortfalls. Leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant children and young people’s care was not tailored in response to this.

Children and young people’s care experiences were not always consistent across departments. Parents and carers told us this would depend on how busy ward and departments were at time of their visit and the number of staff on shift. This was also reflected in the Friends and Family test results.

Staff were concerned care experiences differed particularly at night and weekends when staffing levels were sometimes lower. Staff told us they were doing their best to provide consistent care, but at times found this increasingly difficult and worried they were unable to deliver the good care and the outcomes they wanted.

We requested information how the trust monitored care experience and outcomes and how they used this information to drive improvement. We also requested for evidence to demonstrate how they reviewed equity in care considering the diverse population they serviced. We also asked for data on waiting times on arrival to outpatients and the proportion of waits longer than 30 minutes or if clinics started late and evidence of any meetings were all wait times were discussed and actions taken, this was not provided.

The service was unable to demonstrate and provide evidence that they had undertaken work to understand and meet the diverse health and social care needs of the local community. Therefore, we were not assured children and young people received equitable care and treatment whilst using the service.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

During our assessment we did not speak to any parents / carers of children who were on an end-of-life care pathway. The service did support children and families with complex life limiting conditions and staff did their best to support families and children during this emotional and stressful time.

Staff had policies and guidance to follow when supporting children, young people and their families through end of life and palliative care. The service used advanced decision making like Do Not Resuscitate orders (DNAR) and ReSPECT processes. The ReSPECT process creates personalised recommendations for a person’s clinical care and treatment in a future emergency in which they are unable to make or express choices. These recommendations are created through conversations between a person, their families, and their health and care professionals to understand what matters to them and what is realistic in terms of their care and treatment.